Rheumatoid Arthritis

Question 1

what is rheumatoid arthritis

Answer 1

autoimmune condition where there is inflammation of the synovial membrane and extra articular involvement

Question 2

what is the general outline of RA pathophysiology

Answer 2

thought that genetics/smoking/porphyrmonas gingivitis can cause modification of autoantigens
trigger immune response
macrophages can release cytokines and stimulate FLS cells of the synovial membrane
causes secretion of protease and simulation of osteoclasts
once activated can migrate causing symmetrical arthritis
neutrophils and immune complexes can be found in the synovial fluid

Question 3

which antibodies would support diagnosis of RA

Answer 3

RF
Anti-CCP

Question 4

what are some examples of extra-articular involvement in RA

Answer 4

anaemia (hepcidin release due to inflammation)
nodules
CVS - plaque formation (through inflammation)
fever
lungs - ILD, pleural effusion#
MSK - insulin resistance (weak muscles), thrombocytosis

Question 5

what is feltys syndrome

Answer 5

RA
splenomegaly
granulocytopenia (decreased WBC)

can lead to life threatening infection

Question 6

what are the hand changes which can be seen in RA

Answer 6

swann neck
boutonnière
ulnar deviation
Z thumb

MCPJ and PIPJ tend to be affected early on in disease

Question 7

management of RA

Answer 7

methotrexate
can consider adding in hydroxychloroquine or sulfasalazine (suppress inflammation)
biologics

Question 8

what medications can be used for acute flares of RA

Answer 8

NSAIDs
Glucocorticoids

Question 9

what scoring system can be used for RA

Answer 9

DAS 28
disease activity score to evaluate the level of RA activity in 28 joints